Health Information Exchange - A Critical Assessment: How Does it Work in the US and What Has Been Achieved? Use cases, best practice and examples for successful implementations 1
Agenda Overview of The Sequoia Project History of Exchange in the United States Lessons Learned Discussion 2
3 Overview of The Sequoia Project
The Sequoia Project s Role The Sequoia Project brings together industry and government to systematically address the practical challenges of secure, interoperable nationwide health data sharing SECURE INTEROPERABLE NATIONWIDE 2
The Sequoia Project Initiatives The Sequoia Project s independent initiatives each have their own: Mission Governance Membership Structure The Sequoia Project is an ideal home for projects that require a collaborative environment where multiple parties with differing perspectives can work together. 5
Current Sequoia Project Initiatives The ehealth Exchange is the largest health data sharing network in the US Carequality facilitates consensus on a standardized, national-level interoperability framework to link all data sharing networks RSNA Image Share Validation Program is an interoperability testing program to enable seamless sharing of medical images 6 6
Health Information Exchange in the United States 7
The Largest Health Information Exchange Network in the U.S. An initiative of 8
Introduction to the ehealth Exchange Federal Govt States Regional Networks Care Facilities Tech Vendors Payers Pharmacies Shared Governance and Trust Agreement Common Standards, Specifications & Policies 9
10 Years of Experience A solid proven governance model Common legal agreement minimizes barriers to nationwide exchange Mature capabilities, processes, operations, testing, and strong cultural knowledge base Testing and onboarding have simplified efforts for partners to exchange nationwide Growth is in the number of medical groups Federal partner programs leverage ehealth Exchange as integral part of their interoperability strategy Relatively negligible maintenance costs Recognized by SDOs as significant nationwide community of implementers ONC Conceives the Nationwide Health Information Network (NHIN / NwHIN) First production exchange between Social Security Administration & MedVirginia Participation quadruples & expands to all 50 states 2006 2009 2015 2008 NHIN moves from prototype to production pilot 2012 NHIN transitions from government to private sector & renamed ehealth Exchange 2016 New initiatives increase quality & types of content shared 10
Critical Architecture Decision Centralized Federated Federated with Shared Services (Hybrid) Hub networks The Internet 11
In 2017, the ehealth Exchange connects: All 50 states Four federal agencies (DoD, VA, CMS, SSA) 65% of U.S. hospitals 47 regional and state HIEs in production 50,000 medical groups 3,400+ dialysis centers 8,300 pharmacies Supporting more than 109 million patients 12
National Use Cases and Standards Supported Use Cases Treatment / Care Coordination Military / Veteran Health Disability Benefits Determination Quality Measures Reporting Immunizations Consumer Access Life Insurance Syndromic Surveillance Image Share Specifications & Standards Query: SOAP / SAML + IHE Suite Push: Direct, Document Submission / Admin Distribution Content: C32, CCDA, quality measures FHIR Others under consideration 13
Interoperability Framework to Connect Networks to Networks An initiative of 14
A Changing Landscape A Shifting Marketplace from 2008 to 2015 Greater EHR adoption MU, MACRA and Consumer Directed Exchange driving need for widespread exchange HIEs have evolved and many new types of data sharing networks have developed Evolving role of EHR vendors New types of services for data sharing (e.g. RLS) Growing pressure from policy makers to connect health data silos that are still prevalent State EHR Adoption Rates have Increased from 2008 to 2014 1 2008 2014 15
The Situation Communities of data sharing partners have formed, brought together by specific needs. Some are geographically based, but many other types of data sharing communities also exist. 16
One Framework to Unite Many Networks Carequality is creating a web of interconnected networks Carequality Interoperability Framework Public and private stakeholders developed a trusted exchange framework and common legal agreement to enable data sharing across different networks 17
The Network Effect How do you get nationwide connectivity? Clinic by clinic, hospital by hospital? Data sharing networks have already connected many participants within communities. The connections grow exponentially by connecting these networks. If you connect six clinics, you might reach a few dozen physicians. If you connect six communities, you can reach thousands of physicians. Case Study Example: Exchange began in 2016, connecting in just the first 6 months: 15,000+ Clinics 600+ Hospitals 210,000+ Clinicians 18
19 Lessons Learned
Common Legal Agreement Eliminates one-to-one legal agreements Saves money with uniform contracts, policies and governance Contractual enforcement of compliance Provides transparency Creates clear expectations for participants Provides for oversight and accountability
Interoperability Testing Testing should meet business and technical objectives (e.g. test once, exchange with many) Need for more rigorous testing of clinical content Network-level testing should focus on increasing assurances of interoperability in production Goal should be to reduce network-level testing over time as interoperability is built into products Testing should evolve as health IT capabilities mature Optional vendor/product testing reduced level of effort Automation is the absolute key (quality, fast turnaround loop, continuous testing, cost-efficient) Incremental improvements over time essential Feedback loop to standards development organizations Testing is not a profit center
Recipe for Success Industry led, with strong governmental support and publicprivate collaboration Progress can be accelerated when industry and government are working together toward a more unified direction Capability to exchange doesn t guarantee use Quality and value of the data exchange will encourage use Must align business incentives to drive utilization and fit within clinical work flow Trust is the foundation, but a viable business case is the driver A trust framework is a critical foundation for nationwide data sharing, but is not sufficient without a business case to share data (e.g. value-based payment models) 22
23 Discussion Topics